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November 17, 2009 -- In between drilling, filling, and keeping a business ticking, how much time can a dental practice spend following up on treatment plans with patients who choose not to listen?

While experts agree that it is important to encourage patients to follow through on recommended treatment, they also say there is only so much a dentist can do about no-shows.

Child's dental neglect

In the recent case of a Florida woman who repeatedly ignored her son's dental needs, eventually the authorities had to step in. She was charged with child abuse and transported to jail last week.

Authorities claim that Vanessa Wright, 30, repeatedly failed to take her 5- to 6-year-old son for recommended dental treatments, and that he landed in the hospital with an infection as a result.

“I choose to believe that most mothers would not place their children in harm's way.”
— Beverly A. Largent, D.M.D., immediate past president of the American Academy of Pediatric Dentistry

According to a report by Hernando County Sheriff's Office, Wright first brought her son to the Hernando County Health Department in October 2008 but did not follow through with the treatment recommended by health care providers there. The Dental Program at the Hernando County Health Department provides preventative, restorative, extraction, and root canal services to people age 3 and older who meet the economic eligibility guidelines or who are eligible for Medicaid, according to their Web site.

In February 2009, Wright took her son to Cobbe Dental & Orthodontics in Spring Hill, a private practice that accepts Medicaid. But she again failed to follow through with the recommended treatment, according to the sheriff's report.

On July 23, 2009, the boy was taken to All Children's Hospital in Tampa due to an infection, and was referred to Cobbe Dental once again. That appointment was set for August 19. But for the third time, Wright failed to show up for the appointment, according to the sheriff's office.

Medicaid coverage

This is the second time this year a Florida mom has been arrested for "dental neglect." In May, 19-year-old Tamika White of Bradenton was charged with child neglect after failing to follow through on a dentist’s recommendation to take her young daughter to a specialist to treat the child's advanced tooth decay. White told police she did not take the child to the recommended specialist because the dentist did not take Medicaid.

Lack of Medicaid coverage was not the culprit in Wright's case, however. The sheriff’s report states that Wright did have Medicaid, which would have covered the expense for the treatment at no cost to her. But Medicaid coverage alone does not guarantee patient compliance. A study in this month's Journal of the American Dental Association (November 2009, Vol. 140:11, pp. 1403-1412) concluded that while children with Medicaid coverage were more likely to use health care services, they were no more or less likely to have good general health, good oral health, asthma treatment needs, or dental treatment needs.

Although it is a good office policy to follow up with parents whose children have incomplete treatment plans, there is very little action a dentist can take when the parent either does not want to make an appointment or says that the child has seen another dentist for treatment, Beverly A. Largent, D.M.D., immediate past president of the American Academy of Pediatric Dentistry, told DrBicuspid.com.

It is impossible for many to imagine the challenges faced by many in this country, she said. Perhaps the need for food, clothing, or shelter pushed dental care to the bottom of the list for the family in this story, Dr. Largent added.

Other issues that can get in the way of a parent being able to follow through on recommended treatment include lack of transportation or the inability to leave work to take the child to the appointment.

"I choose to believe that most mothers would not place their children in harm's way, and I think this is an unusual circumstance," Dr. Largent said.

But even if parents put their children in danger, dental neglect is a difficult problem to report to Social Services. In order to make an appropriate report, there must be proof that the parent was aware of the disease, and the severity of the disease, willfully neglected the treatment (multiple broken appointments), and that there are no barriers to care, such as not having financial means to pay for the treatment, said Dr. Largent.

"Although dentists identify treatment plans, refer patients for additional care, and encourage continual dental maintenance, they are not in a position to force patients to obtain treatment, just like any other physician," said Dr. Hoffman.

Improving compliance

So what can dentists do to improve patient compliance?

According to Dr. Hoffman, they can advise them about how long a current dental piece could last, what temporary actions could be taken, and how the affliction affects their overall health. Also, they could tell patients that bacteria from dental ailments may enter the blood stream and affect heart functions, cause diabetes complications, affect child birth weight and many other health issues.

Dr. Largent said she spends "an inordinate amount of time" on patient education about prevention and simple treatment.

She gave the example of a Hispanic mother whose child had three badly decayed front teeth that needed to be removed. However, the father, who was not at the appointment, had laid down the law that these teeth would not be removed, the mother explained. Through an interpreter, Dr. Largent told the mother that the child's face would eventually swell and that she would develop a fever. She even went so far as to remind the mother of Diamonte Driver, the child who died in Maryland because of an abscessed tooth.

But the Hispanic mom was at a disadvantage because of her lack of understanding of the English language, Dr. Largent said.

"The definition of dental neglect is not a simple one, but has many layers involved," she said.

Wright's bail has been set for $10,000. The Florida Department of Children and Families is also investigating the matter.

I'd suggest anyone concerend about this read the study. The economics are completly unrealistic. In much of the West , you can 't hire a hygineist for less than $50 an hour (exclusive of benefits). The study bases its total operations cost at $48 an hour.